Abstract
BACKGROUND: In Sub-Saharan Africa, unmet need for contraceptives often remains high among adolescent girls and young women (AGYW), leading to unintended pregnancies. Yathu Yathu, a cluster-randomised trial of a community-based intervention conducted in two communities in Lusaka, Zambia (2019-2021), aimed to provide sexual and reproductive health services, including contraceptive services, to adolescents and young people. The trial showed no impact on pregnancy related outcomes. Hence, this analysis examined the characteristics of AGYW aged 15-24 with an unmet need for modern contraceptives and who experienced an unintended pregnancy. We also explored access to and reach of contraceptive services through Yathu Yathu. METHODS: Secondary analysis of Yathu Yathu endline survey data. Using logistic regression, adjusted for cluster, we explored factors associated with unmet need for modern contraceptives and unintended pregnancies among AGYW in the intervention arm and assessed whether these associations differed in the control arm. Using routinely collected service delivery data from the intervention arm, numbers of AGYW accessing hormonal contraceptive services were described by age, community, educational attainment, and marital status. RESULTS: In the intervention arm, 395 AGYW ever had sex. Unmet need for modern contraceptives was 40.6% (101/249) among AGYW who had sex in the last 12 months and wished to prevent or space childbearing. Unmet need was higher among younger and single/never married AGYW; in control zones unmet need was additionally higher among those currently in school or with infrequent discussion about sexual health promotion with their sexual partners. Among AGYW ever having had sex, 42.1% (165/392) reported an unintended pregnancy. This was higher among AGYW aged 20-24 years and currently not in school, and additionally among those in control zones who reported food absence. According to the routinely collected data, 12.3% (859/7005) of AGYW in intervention zones initiated hormonal contraceptives; 53.6% (460/859) returned for refills. Uptake was higher among AGYW aged 20-24, residing in community 2, with no/primary education and being married/cohabiting (p < 0.001). CONCLUSIONS: This study highlights persistent challenges in addressing unmet need for modern contraceptives and unintended pregnancies among AGYW, emphasising the need for targeted interventions to improve equitable access among younger and single/never married AGYW. TRIAL REGISTRATION: NCT04060420; https://clinicaltrials.gov/ct2/show/NCT04060420 ; and ISRCTN75609016. Registration date: 2019-08-12.